Original articleIrregular Menses Linked to Vomiting in a Nonclinical Sample: Findings from the National Eating Disorders Screening Program in High Schools
Section snippets
Methods
The national nonprofit organization, Screening for Mental Health, that led the initiative sent notices to high schools across the country inviting them to participate in the one-time screening program in 2000. Of the 270 public, private, and parochial schools that enrolled in NEDSP, 152 high schools from 34 U.S. states administered the screening instrument to their students. Of these participating schools, 98 returned completed screening forms for data analysis by Screening for Mental Health.
Results
Table 1 presents selected characteristics, eating disorder symptoms, and menstrual irregularity in the full sample and subsample of girls with BMI in the low–moderate/moderate weight range. For the full sample, the mean age was 15.8 years, and 85.8% were of white race/ethnicity. Vomiting one to three times per month to control their weight in the previous 3 months was reported by 8.9% of girls, and an additional 3.1% reported vomiting once per week or more often. More than 14% of the girls
Discussion
In a national eating disorders screening initiative in U.S. high schools, we found a strong association between vomiting frequency and irregular menses in adolescent females aged 14–19 years. When restricting analyses to girls within a healthy weight range, the associations persisted at a similar magnitude, indicating that vomiting, rather than anthropometric characteristics such as extreme BMI, may be likely to explain observed associations. In girls within the low–moderate/moderate weight
Acknowledgments
The authors acknowledge Nancy Conlon, S. Jean Emans, Barbara Kopans, Joelle Riezes, David Wypij, Anne Zachary, the Massachusetts Eating Disorder Association, and the NEDSP advisory board for their contributions. Thanks are also extended to the thousands of students, faculty, and staff from high schools across the country who made the screening program possible. The National Eating Disorders Screening Program was funded by the McKnight Foundation. This work was supported by the McKnight
References (45)
- et al.
The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication
Biol Psychiatry
(2007) - et al.
Prevalence of eating disorders in female and male adolescents (14–15 years)
Eat Behav
(2004) - et al.
Prevalence and risk and protective factors related to disordered eating behaviors among adolescents: Relationship to gender and ethnicity
J Adolesc Health
(2002) - et al.
Menstrual cycle irregularity in bulimia nervosaAssociated factors and changes with treatment
J Psychosom Res
(2000) Reproductive health in women with eating disorders
J Obstet Gynecol Neonat Nurs
(2005)- et al.
Metabolic and endocrine indices of starvation in bulimia: A comparison with anorexia nervosa
Psychiatry Res
(1985) - et al.
Hypothalamic-pituitary-gonadal function in anorexia nervosa and bulimia
Psychiatry Res
(1989) - et al.
Thyroid function in bulimia nervosa
Psychoneuroendocrinology
(1996) - et al.
Biological and psychological correlates of intermittent dieting behavior in young womenA model for bulimia nervosa
Physiol Behav
(1996) - et al.
Hypothalamic-pituitary-thyroidal axis alterations in bulimic patients
Am J Clin Nutr
(1988)
The effect of bingeing and vomiting on hormonal secretion
Biol Psychiatry
Eating disorder NOS (EDNOS): An example of the troublesome “not otherwise specified” (NOS) category in DSM-IV
Behav Res Ther
Assessment of eating disorders: Comparison of interview and questionnaire data from a long-term follow-up study of bulimia nervosa
J Psychosom Res
Impact of anorexia, bulimia and obesity on the gynecologic health of adolescents
Am Fam Phys
The spectrum of eating disorders in young women: A prevalence study in a general population sample
Psychosom Med
Youth Risk Behavioral Surveillance System; Youth Online Comprehensive Results
Effects of anorexia nervosa on clinical, hematologic, biochemical, and bone density parameters in community-dwelling adolescent girls
Pediatrics
Patterns of menstrual disturbance in eating disorders
Int J Eat Disord
Amenorrhea in anorexia nervosaNeuroendocrine control of hypothalamic dysfunction
Int J Eat Disord
Self-induced vomiting and bulimia nervosa: An undetected problem
Br Med J (Clin Res Ed)
The clinical features of bulimia nervosa
Br J Psychiatry
The effect of gynecologic age, body mass index and psychosocial environment on menstrual regularity among teenaged females
Acta Obstet Gynecol Scand
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